Esophageal Cancer: Surgery

Pictured: James Huang Thoracic surgeon James Huang prepares for a procedure in a patient with esophageal cancer. Surgery can be curative if the cancer is found early and has not spread beyond the esophagus.

Surgery is an important part of treatment for many people with esophageal cancer. In the procedure called an esophagectomy, the goal is to remove all of the tumor in order to prevent its regrowth and spread.

Memorial Sloan Kettering Cancer Center is among the most experienced centers in the United States in performing surgery for esophageal cancer:

  • Our thoracic surgeons perform more than 120 operations for esophageal cancer each year, among the most in the country. Studies have shown that cancer centers that perform more surgeries deliver better results for patients, including better survival rates, than those with less experience.
  • We have among the lowest rates of complications following esophageal surgery in the country.
  • Our thoracic surgeons are experts in performing complex esophageal surgery, including advanced minimally invasive techniques and robotic surgery. These approaches have been shown to lead to faster recovery after surgery than traditional open surgical approaches.

Because surgical oncologists at Memorial Sloan Kettering work as part of a multidisciplinary team, we are also very careful to recommend surgery only as part of a comprehensive treatment plan that will offer you the best results.

When Surgery Is Performed

Whether your doctors recommend surgery as the initial treatment for your esophageal cancer depends on several important factors, including:

  • Whether the cancer is adenocarcinoma or squamous cell carcinoma. Squamous cell carcinoma does not always require surgery. It can sometimes be managed with chemotherapy and radiation therapy alone.
  • The size of the tumor
  • How deeply the cancer has invaded the layers of tissue in the wall of the esophagus
  • Whether the cancer has spread to the lymph nodes
  • Your overall health

In some cases, limited precancerous changes or very early stage tumors may be treated with a simple endoscopy and removal of the diseased inner lining of the esophagus — a technique called endoscopic mucosal resection (EMR). Radiofrequency ablation (RFA), an endoscopic procedure used to treat remaining areas of disease including Barrett’s esophagus, may also be used. If successful, surgery may be avoided in these cases.

Surgery is the best treatment option for more-advanced tumors, or early tumors and precancerous changes in the lining of the esophagus that cannot be treated with endoscopic techniques.

For most patients — because diagnosis of esophageal cancer usually happens only once it has reached an advanced stage — surgery is not the first treatment given. In many cases, patients first receive a combination of chemotherapy and radiation therapy to shrink the tumor and to increase the likelihood that any remaining cancerous tissue will be completely removed during a later surgery.

Esophagectomy

During surgery for esophageal cancer, the thoracic surgeon removes the tumor along with part of the normal esophagus, as well as a margin of tissue around the cancer and nearby lymph nodes to which cancer cells may have spread. This procedure is called an esophagectomy. Once these tissues are removed, the stomach is reattached to the remaining part of normal esophagus. In some cases, the colon or small intestine is used instead of the stomach to complete the connection.

Esophagectomy can be performed using open surgical methods or minimally invasive techniques. Your surgeon will carefully consider the appropriate approach for you.

Minimally Invasive Robotic Surgery

Many operations for esophageal cancer at Memorial Sloan Kettering can now be performed using minimally invasive approaches, including robotic-assisted approaches. Minimally invasive surgery is a set of techniques that use small incisions to enter the body, limiting the amount of healthy tissue that is affected during an operation. Minimally invasive approaches are not effective for all patients with esophageal cancer, but when appropriate these techniques may offer a variety of benefits, including:

  • Shorter hospitalization
  • Less pain
  • Decreased complications, particularly in older patients

Memorial Sloan Kettering surgeons are leaders in performing robotic-assisted surgery. Our team of thoracic surgeons is increasingly integrating robotic assistance into esophageal surgery, including complex esophageal cancer operations. This sophisticated surgical tool offers finer precision than is possible with other minimally invasive techniques.

Using a device called the da Vinci® Surgical System, the surgeon performs the operation while seated at a console that has a viewing screen as well as hand, finger, and foot controls. The screen projects a three-dimensional image of the esophagus and the surrounding area. Because the area of surgery is magnified to ten times its actual size, the surgeon can view the surgical site in exquisite anatomical detail. The robot then translates the surgeon’s hand, wrist, and finger movements into very fine, real-time movements of the instruments inside the patient.  Advanced robotic optics, such as fluorescence imaging, allow our surgeons to clearly visualize the blood supply and further improve the way these operations are performed.

Despite the advantages of robotic surgery, this approach is not effective for all patients. Your doctor will discuss this technique with you if it is considered an appropriate part of your treatment.

Endoscopic Mucosal Resection and Radiofrequency Ablation

Endoscopic mucosal resection (EMR) is a technique for removing precancerous areas or small tumors when they are caught at an early stage. Using a flexible, narrow tube called an endoscope, the gastroenterologist or surgeon removes precancerous or cancerous tissue from the inside lining of the esophagus.

When appropriate, thermal therapy such as radiofrequency ablation (RFA) may also be incorporated along with EMR in treatment of precancerous areas or small tumors. In RFA heat energy is delivered by endoscopy to treat precancerous areas, such as Barrett’s esophagus. Using these techniques may avoid the need for surgical removal of the esophagus (esophagectomy) in certain patients.

After Your Surgery

Surgery for esophageal cancer can sometimes lead to complications. These can include:

  • Infections
  • Leaks and blockages where the remaining esophagus and the stomach, colon, or small bowel are reattached
  • Gastroesophageal reflux, the movement of stomach fluids into the esophagus
  • Early satiety, in which patients feel full after eating only a small portion of a meal
  • Dumping syndrome, in which food or liquid moves too fast into the small intestine. This syndrome can cause sweating, dizziness, cramps, and diarrhea.

Doctors, nurses, and other specialists on your esophageal cancer team at Memorial Sloan Kettering will continue to monitor your progress after surgery and are experts in recognizing and addressing these and other side effects. Notify your cancer care team if you experience any discomfort after you leave the hospital. Treatments are available to address many of these symptoms.